Tag Archives: College Counseling

When Europeans first made contact with the indigenous peoples of the Americas, a path toward Eurocentrism was set in the Western Hemisphere. In the years since the conquest and colonization of North America and the establishment of the United States, the cultural values and social policies of this country have favored people of Western European heritage.

Although the sociopolitical and cultural superiority of Europeans validates the experience of white Americans, these edicts render Latinx communities marginalized or invisible. What is worse, people of Latinx descent might come to accept the superiority of the white population. When this occurs, a person is said to have internalized racism.

In the 2006 article “Naming racism: A conceptual look at internalized racism in U.S. schools,” Lindsay Pérez Huber, Robin N. Johnson and Rita Kohli defined internalized racism as “the conscious and unconscious acceptance of a racial hierarchy in which whites are consistently ranked above People of Color. … It is the internalization of the beliefs, values and worldviews inherent in white supremacy.”

Internalized racism is thought to have negative physical and psychological consequences for people of color. Even so, the bulk of the research on internalized racism has focused on communities of African descent. Most of this research can be credited to Jerome Taylor, as either he conducted these studies or other researchers used his survey instrument, the Nadanolitization scale, to assess internalized racism.

Research studies have linked internalized racism in communities of African descent with increased abdominal fat, higher glucose levels and larger waist circumference, which are indicators of more serious health concerns. Additionally, internalized racism has been linked to marital dissatisfaction, increased depressive symptoms, increased stress, decreased self-esteem and decreased life satisfaction. In one of the few studies examining internalized racism in Latinx communities, I found that internalized racism was negatively related to ethnic identity development among Latinx undergraduates.

Although it appears that internalized racism has a negative impact on communities of color, we do not know why racism gets internalized. Two prominent theories are that 1) exposure to racism leads to its internalization and 2) acculturation to a racist society leads to the internalization of racist values. The exposure to racism hypothesis is largely grounded in social conditioning, in which repeated exposure to racism ultimately leads an individual to accept racist notions as truth. The acculturation hypothesis argues that by adopting the values of a racist society, the individual must accept racist notions in conjunction.

The research

Given the limited research on internalized racism in Latinx communities and the desire to better understand why racism is internalized, I undertook a study guided by two research questions:

1) Does exposure to racism predict the internalization of racism in Latinx undergraduates?

2) Does acculturation to U.S. society predict the internalization of racism in Latinx undergraduates?

(A quick note on usage of the word Latinx. Spanish is a gendered language with masculine and feminine pronouns; some readers might be more familiar with the usage of Latina and Latino, for example. To break from these gendered conventions and to be more inclusive of folks who do not identify strictly with one gender, scholars and activists have called for the usage of Latinx.)

Participants in this study were recruited from college Latinx student organizations. Using a variety of group email lists, I reached out to faculty and student advisers at two- and four-year colleges and universities and solicited their aid in recruiting potential participants. In total, 350 first-generation Latinx students participated in this study. These participants represented 93 universities from 29 states. All of the participants self-identified as Latinx. Furthermore, 75.7 percent of the participants identified as female, 20.6 percent identified as male, 0.3 percent identified as transgender and 1.1 percent identified as other (2.3 percent of participants declined to identify). The average age of participants was 21.81.

Participants completed an online survey consisting of the Everyday Discrimination Scale (EDS), the Abbreviated Multidimensional Acculturation Scale (AMAS) and the Mochihua Tepehuani scale. Furthermore, I used hierarchical linear regression in an attempt to answer my research questions regarding the cause of internalized racism. The Mochihua Tepehuani, a revised version of the Nadanolitization scale adapted to assess internalized racism in Latinx communities, acted as the criterion variable in the analysis. The EDS assessed exposure to racial discrimination. The AMAS was used to assess participants’ degree of acculturation to U.S. culture and values. Both exposure to racism and acculturation acted as predictor variables in this study.

Through hierarchical linear regression, I was able to assess the strength of the overall model with both exposure to racism and acculturation acting as predictors of internalized racism and the individual impact of the two predictor variables. Although the overall model was statistically significant, the amount of variance accounted for by this model was slight (R2 = .06, p < .001). This means that the relationship between the predictor and criterion variables is not likely due to chance, but that the predictive power of combined variables is small. Individually, exposure to racism (β = .14, p < .05) and acculturation (β = .20, p < .001) were significant predictors. In this case, a one standardized point change in exposure to racism or acculturation produced a .14 or .20 standardized point change, respectively, in the internalized racism scores of participants.

Based on these results, it appears that both research questions can be answered in the affirmative: Both exposure to racism and acculturation to U.S. society predict internalized racism in Latinx undergraduate students.

Interrupting racism’s impacts

Although most counselors might intuitively know that racism negatively affects Latinx undergraduates, the findings of this study provide empirical evidence of racism’s impacts. Furthermore, the impacts of racism — hurt feelings, a sense of exclusion and the like — are not fleeting. Rather, the impacts linger in the minds of Latinx undergraduates. Over time, the cumulative impacts of racist encounters can lead to the internalization of racism, ultimately steering Latinx undergraduates to conscious or unconscious acceptance of the cultural and intellectual superiority of whites.

To intervene in the internalization of racism, counselors are encouraged to help Latinx undergraduates talk through instances of discrimination. This begins with validating students’ perceptions that they have experienced racism. The challenge with processing incidences of discrimination is that racism can be subtle and subjective — as in the case of microaggressions. This inability to objectively say that a racist incident has occurred might lead some individuals to dismiss or downplay the incident.

Recently, I was working with a university student who shared a story of experiencing discrimination on campus. The student, uncertain of how to make sense of the event, shared her experience with a good friend, who immediately told her she was making a big deal out of nothing. After talking through these events with me, the student came to the realization that her friend’s reaction was more hurtful than the original discriminatory event had been. When processing an incidence of racism, it is important to remember that the perception of the event can be more important than the facts of the event. Therefore, a microaggression might not be a big deal for me as a Chicano counselor who has dealt with racism all of my life, but it could be a huge deal for a student who is experiencing racism for the first time. As such, we should take time to validate the perceptions of the student.

Another strategy I have found useful in helping Latinx undergraduates process incidences of discrimination is to examine the source of racist notions. Beverly Tatum (in her classic text Why Are All the Black Kids Sitting Together in the Cafeteria?) explained that biased thoughts are a product of limited information. From this perspective, bias is a product of the perpetrator’s ignorance; the person possesses limited information about the Latinx community and has made a gross generalization.

After talking through a student’s emotions surrounding an incident of discrimination, I will introduce Tatum’s perception of bias. My hope is for the student to realize that racism is not the student’s fault. It is not a reflection of the student’s culture or heritage, but instead is the product of a biased perpetrator and a racist society. This typically alleviates some of the student’s stress and allows the student to see the interaction in a new light.

Avoiding assimilation

The melting pot and other assimilationist notions can be viewed as an American ideal. Assimilation tends to gain popularity in communities of color during periods of heightened racism. Since the presidential election of 2016, Latinx communities have faced an onslaught of racist depictions by politicians and media outlets. This is especially true of the Mexican community, whose members have been described as drug dealers, rapists and murderers by President Donald Trump.

In an attempt to avoid racism and discrimination, Latinx parents might try to expedite assimilation in their children by promoting the adoption of traditional American cultural values and the abandonment of Latinx values. The belief is that Americanization will enable Latinx youth to pass as Americans and avoid racism. Alas, the promotion of assimilation leads to the portrayal of American culture as being superior to Latinx culture — the very definition of internalized racism described earlier.

Unfortunately, some Latinx individuals are overdetermined by their physical features; dark-skinned folks such as myself can never pass as Euro American. Regardless of attempts to assimilate, we will always be recognized for our cultural heritage. As such, an assimilationist upbringing can backfire if Latinx students experience rejection from their white peers for being too brown. These same students can then also be excluded by their Latinx peers for not being Latinx enough. In part for this reason, I encourage counselors to help Latinx families take a strength-based perspective on their cultural heritage and to look to biculturalism over assimilation.

Assimilationist notions also have a history in higher education. Respected higher education scholar Vincent Tinto described the need for students to assimilate to the college campus and leave the home culture behind to be successful and persist to graduation. Alas, campus climates are a reflection of Euro-American values. Higher education personnel who promote an assimilationist agenda of higher education success also promote notions of American cultural superiority, thus increasing the Americanization of Latinx undergraduates and, potentially, increasing the internalization of racism.

Fortunately, higher education scholars such as Sylvia Hurtado have recognized the flaws in Tinto’s early work and promoted models of student engagement that recognize the positive influence of cultural heritage, family and community. Furthermore, Hurtado and her colleagues have argued that assimilationist models do not accurately account for the success and persistence of students of color in higher education.

Based on the work of Hurtado, a multidimensional approach might be better for promoting the success of Latinx undergraduates and avoiding the internalization of racism. In a multidimensional approach, Latinx students are encouraged to retain their ethnic culture, remain engaged with cultural support systems and view culture as a resource in promoting their academic success. Similarly, undergraduates learn about the culture of their institution and the skills necessary for them to successfully navigate higher education. A significant body of research supports this multidimensional approach, but for this perspective to be successful, higher education personnel must recognize the value of traditional support systems.

A first step toward this is helping Latinx students recognize the value of their culture and heritage. This can include promotion of Latinx ethnic identity, such as exploring what it personally means to be Latinx and building connections with other Latinx students, for example. Positive Latinx ethnic identity is linked to increased persistence in higher education and higher GPA and might also block the internalization of racism.

Second, institutions of higher education can also work to affirm Latinx culture on campus. This includes holding cultural celebrations; recognizing the achievements of Latinx students, staff, faculty and community members; and providing space for Latinx students to study and socialize.

These combined interventions signal to Latinx students that their culture and community are of value, reducing the perceived superiority of whiteness and, subsequently, blocking the internalization of racism.

Conclusion

Although counselors might intuitively know that racism and internalized racism negatively affect Latinx undergraduates, the full impact of internalized racism will remain unknown until additional research is conducted. Within the context of higher education, it would be helpful to know how internalized racism influences academic performance and persistence. In addition, it would be helpful to know how internalized racism affects self-esteem, academic self-efficacy and depression. Finally, knowing how and why racism is internalized might lead to better strategies to interrupt this process.

Although additional research is needed on the topic of internalized racism in Latinx undergraduates, this study represents an important step in empirically documenting factors that lead to the internalization of racism. It is my hope that this article inspires counselors to consider the impacts of internalized racism and strategies that they might take to help Latinx undergraduates avoid internalized racism.

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Knowledge Share articles are developed from sessions presented at American Counseling Association conferences

Carlos P. Hipolito-Delgado is associate professor in counseling at the University of Colorado Denver. He researches the ethnic identity development of Chicanas/os and Latinas/os, the effects of internalized racism on students of color, the sociopolitical development of students of color and how to improve the cultural competence of counselors. He currently serves as the Association for Multicultural Counseling and Development representative on the ACA Governing Council and is the past chair of the ACA Foundation. Contact him at carlos.hipolito@ucdenver.edu or on Twitter @DrCarlosHD.

Anxiety disorders are the most common mental illness in the United States, affecting 18 percent of the adult population, or more than 40 million people, according to the National Institutes of Health. Among adolescents the prevalence is even higher: 25 percent of youth ages 13 to 18 live with some type of anxiety disorder.

Anxiety disorders are often coupled with sleeplessness, depression, panic attacks, racing thoughts, headaches or other physical issues. Anxiety can run in families and be a lifelong challenge that spills over into all facets of life, from relationships and parenting to the workplace.

The good news is that anxiety disorders are manageable, and counselors have a plethora of tools to help clients lessen the impact of anxiety. Caitlyn McKinzie Bennett, a licensed mental health counselor, says she regularly talks this through with her clients at her private practice in Orlando, Florida. She often uses an analogy of ocean waves with clients: Anxiety comes in waves, and managing the disorder means learning coping tools and strategies to help surf those waves rather than expecting the waves to disappear entirely.

“Anxiety can be a long-term thing,” says Bennett, who is also a doctoral student in counselor education at the University of Central Florida. “With clients, I try and explain that [anxiety] is the body’s response that something’s not right — based off of what’s happened to you [such as past trauma] or what’s happening currently. Then we can work to accept it, cope and be happier in your life. Some things you can’t necessarily get rid of in their entirety, and that’s OK. It’s learning to be you and have a fulfilling life with anxiety, where you’re able to feel anxious and [still] be productive and be a mother, a student, a partner. I try and normalize that [anxiety is] going to come and go. It’s OK, and it’s human.”

Anxiety doesn’t happen in isolation

Everyone experiences anxiety from time to time, such as worry over an upcoming work responsibility, school exam or first date. Anxiety disorders, however, are marked by worry and racing thoughts that become debilitating and interfere with everyday functioning.

“It’s a normal part of life to experience occasional anxiety,” writes the Anxiety and Depression Association of America on its website (ADAA.org). “But you may experience anxiety that is persistent, seemingly uncontrollable and overwhelming. If it’s an excessive, irrational dread of everyday situations, it can be disabling. When anxiety interferes with daily activities, you may have an anxiety disorder.”

A number of related issues fall under the heading of anxiety disorders in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), including specific phobia, panic disorder, separation anxiety disorder, social anxiety disorder, generalized anxiety disorder and others. According to the DSM-5, anxiety disorders “include disorders that share features of excessive fear and anxiety and related behavioral disturbances. Fear is the emotional response to real or perceived imminent threat, whereas anxiety is anticipation of future threat.”

Racing thoughts, rumination and overthinking possibilities — from social interactions to decision-making — are central to anxiety. In addition, people with anxiety often struggle with insomnia or sleeplessness and physical symptoms such as a racing heart, sweaty palms and headaches, says Bennett, an American Counseling Association member who is currently leading a study for her doctoral dissertation on the effects of neurofeedback training on college students with anxiety. Adolescents sometimes turn to self-harming behaviors such as cutting or hair pulling to cope with anxiety. In adults and adolescents, anxiety can manifest in physiological issues such as stomachaches or irritable bowel syndrome.Although adults may channel their anxiety into physical problems, they’re also generally much more capable than adolescents and children of identifying and articulating the anxious thoughts, ruminations and social struggles that they’re facing, Bennett says.

Bennett worked with a 14-year-old female client whose anxiety had manifested as the behaviors of obsessive-compulsive disorder (OCD), including avoiding the number six, leaving her closet door open a certain way and struggling with crossing thresholds. Bennett worked with the client to identify her triggers and find coping mechanisms, such as connecting with friends and her Christian faith.

“A big part of her improvement was creating the awareness of what was happening,” Bennett says. “Typically there’s a large, irrational fear. With her, she was afraid that her mom was going to die. She would focus on it so much that it would cause her to start the [OCD] behavior. … For her, it felt so real. It was so scary for her that she felt compelled to do these behaviors to keep her mom alive, so to speak.”

Bennett worked with the young client to confront her fears in small doses through exposure therapy, such as listening to a song at volume level six and talking through how she felt afterward. This method allowed Bennett to first address the client’s OCD behaviors and then — once trust was built and the client had progressed — move on to work through the bigger, deeper issue of her fear of her mother’s death.

“It helped her to feel safe enough and have the confidence to work through some smaller things and move on to work on bigger things,” Bennett says. “For her it was talking it out, normalizing that for her and drawing attention to [her anxious behaviors].”

Christopher Pisarik is an associate professor in the Division of Academic Enhancement at the University of Georgia and a licensed professional counselor (LPC) who works with students in need of academic support. He says that stress and irregular sleep and eating patterns — which are often ubiquitous parts of college life — can go hand in hand with anxiety.

“Sleep is a big one — if they’re just not sleeping, or sleeping too much,” says Pisarik, who also treats many college-age clients at his private practice in Athens, Georgia. “This is really, really common — clients who can’t get to bed until 4 a.m., and then they can’t get to class, and it snowballs. Their thoughts just race with worry. … Sleep seems to be a big diagnostic indicator [for anxiety], and not being able to go to bed. [I ask clients,] ‘What are you thinking about, and can you stop thinking about this? Is that what’s keeping you from getting back to sleep?’ They get tired and fatigued, and it’s perpetuated.”

In addition, anxiety is often coupled with — or is an outgrowth of — other mental illnesses, most commonly depression. Counselors will need to treat a client’s anxiety alongside other diagnoses, Bennett says. For example, a client with schizophrenia will have hallucinations that provoke extreme anxiety. If the counselor doesn’t address the client’s anxiety, those symptoms will get worse, explains Bennett.

“Depression and anxiety are like brother and sister,” she adds. “They play off of each other and exacerbate the symptoms. You need to work through both. I don’t think I’ve ever worked with anyone who solely experienced anxiety.”

Stephanie Kuhn, an ACA member and LPC at the Anxiety Treatment Center of Greater Chicago, agrees. She regularly sees client anxiety paired with other issues such as specific phobias, insomnia, chronic pain issues, depression, panic disorders and OCD.

“It’s never really one thing,” Kuhn says. “It’s never just anxiety.”

Pumping the brakes on racing thoughts

The first step for many people who struggle with anxiety is to create awareness of their thoughts and then learn to manage those thoughts with a counselor’s help. Although the strategy of identifying negative self-talk and addressing one’s thoughts is old hat to most counselors, it may be an entirely new concept for some people, especially younger clients, says Pisarik, an ACA member who uses cognitive behavior therapy (CBT) in his private practice. Clients with anxiety often polarize, exaggerate or catastrophize details in their minds as they ruminate over them, he explains.

“Even being able to identify anxious thoughts is big,” Pisarik says. “They just assume it’s normal to walk around [feeling] anxious because of these thoughts. … It gives them a language and a real usable and rudimentary skill they can use in the moment when they’re walking in [to a stressful exam]. They can identify that their inner narrative isn’t healthy.”

For example, a college student might come to a counselor expressing worry about an upcoming exam in a class that he or she needs to pass for a major in pre-med. The student might have allowed negative and catastrophic thoughts to snowball: “If I get a C on this test, I will never get into medical school, which will derail my entire career plan and make my parents angry and disappointed.”

“For … a student who is 20 years old and [still] learning to think critically, it would be easy to blow everything out of proportion and catastrophize everything,” Pisarik says. “I am really big on helping them understand negative thinking and false cognitions, and getting them to self-monitor and renarrate [their unhealthy thoughts].”

Following the CBT approach, Pisarik says he would talk such clients through their thought patterns to identify and restructure their negative thoughts about the exam. He would also suggest that they focus on and remind themselves of prior successes, such as other exams or classes in which they earned A’s and B’s.

“I would try and systematically educate the client [about] what type of thinking that is,” Pisarik continues. “There are many doctors out there who got C’s and got into medical school, and probably [who] got C’s in medical school. I will explain that they are catastrophizing this … [and] try and get them to think about it in a different way, evaluate it carefully and create a different narrative about it. Are there people who have gotten C’s and gotten into medical school? If it stops you from getting into medical school, would that be the worst thing in the world?”

“It takes a consistent effort to practice and challenge one’s thinking,” adds Pisarik, who co-authored the article “A Phenomenological Study of Career Anxiety Among College Students.” The article will be published in the December issue of The Career Development Quarterly, the journal of the National Career Development Association, a division of ACA.

CBT works well for anxiety because “it lets people see that their own thinking and their behaviors are not productive for the way they want to live or the life they’re living right now,” says Kuhn, who uses both CBT and exposure therapy with her clients at the Anxiety Treatment Center of Greater Chicago. “It’s giving people an outside perspective — getting them to look at their own thoughts and behaviors objectively rather than letting those anxious thoughts take over everything, making it harder to function.”

One way Kuhn works with clients on challenging their unhealthy thoughts is by asking them to identify the best, worst and most likely outcomes of situations they are ruminating over. “I ask, ‘Would [the outcome] matter in a week, a month or a year from now?’ Typically the answer is no,” Kuhn says. “After we go through that, we reframe the original thought [and] transform it into something more rational, more realistic.”

Both Pisarik and Kuhn encourage their clients to keep thought logs to track anxious thoughts and the situations that triggered them. This exercise increases self-awareness, helps identify triggers and creates an opportunity to discuss how the client might change the negative narrative.

“Writing helps a lot because it slows people’s minds down, and they can go back and read about it,” Kuhn says. “Creating that awareness is the only way to understand yourself, understand what you’re worried about and be able to accept it and push it away.”

In addition to using thought logs, Pisarik gives his clients a list of automatic negative thoughts, or ANTs, to check themselves against. The collection lists the most common types of unhealthy, anxious thoughts and types of thinking, including catastrophizing and either-or thinking (polarizing).

Kuhn has a particular phrase that she often repeats with clients: “Handle it.” She acknowledges that it’s not the most empathic of mantras, but it does help to focus on the manageability of anxiety. With clients, she works toward a goal of “being able to sit with the uncomfortableness [of anxious thoughts] and tolerate the stress.”

Kuhn says her style when working with clients matches her personality: “Let’s go forward and hit our fears hard instead of tiptoeing around them.”

Exposure therapy, which introduces things in small, controlled increments in session that make a client anxious, is another good way to focus on handling anxiety, Kuhn adds. Whether the scenario is a fear of speaking up in class or a fear of being rejected by a loved one, exposure therapy can help clients learn to live with the issue and the anxious feelings that come with it.

“When I talk to people about ‘handling it,’ it’s creating that awareness and understanding [of] themselves that they’re able to manage or take on more than they think they can,” Kuhn says. “Anxiety a lot of the time makes us believe that we can’t handle the tiniest things. That’s why our body has created or learned how to respond to things in an overactive or hypersensitive way.” This is most commonly experienced in our fight-or-flight response, she says.

Managing worry and taming anxiety

From CBT and mindfulness to a focus on wellness and coping strategies, professional counselors have a wide range of tools to help clients who struggle with anxiety. Here are some ideas and techniques that can be particularly useful.

> Controlling the controllables. Kuhn says it can be helpful for clients to talk through and identify what is out of their control during situations that make them anxious. “A lot of times, anxious clients want control over everything, and that’s just not realistic,” Kuhn says. “It’s important to go over what’s controllable and what’s not. That creates awareness and a pathway to reevaluate [their] own thinking and behavior. I like to call it ‘controlling the controllables.’ I talk with clients about this a lot.”

Kuhn often uses an exercise with clients in which she draws a target with concentric circles. Things that clients can control, such as their own thoughts and behaviors, go in the center circle. Things that they partially control, such as their emotions or what they focus on sometimes, go in the middle ring. Things that are out of their control, such as what other people think or do, go in the outside circle. In a simpler alternative, Kuhn draws a center line down a piece of paper and works with clients to list what is and isn’t in their control in situations that make them anxious.

> Creating common ground. Kuhn says she also talks openly with clients about how common anxiety is, alerting them that they are among literally millions of Americans who are battling the same challenge. “I let them know they are not alone. It creates a universality,” Kuhn says. “To let people know that they’re not the only ones suffering like this can help. … It does create a common ground for people not to feel ashamed of [their anxiety] or feel like they can’t talk to someone about it. Just creating that education typically makes people feel a ton better.”

> Acknowledging and naming worry. Journaling and making lists to document anxious thoughts can help clients address and reframe the everyday rumination that accompanies anxiety. Kuhn offers two variations on this intervention: worry time and the worry tree.

With “worry time,” clients set aside a dedicated amount of time (Kuhn suggests 30 minutes) every day to write down any anxious thoughts that are troubling them. Clients don’t need to engage in long-form writing to complete this exercise, Kuhn says. Making a bulleted list or jotting thoughts down on sticky notes will work just as well. When the designated time is up, clients put all the notes in a box or container that they have set aside for this purpose. This action signifies that they are leaving those thoughts behind and can move on with the day.

“They have to leave those thoughts or sticky notes there and be done with them,” she says. “Obviously more [anxious] thoughts will come, but you have to remind yourself to leave them behind.”

With Kuhn’s “worry tree” intervention, clients create a flowchart of their anxious thoughts. With each item, clients ask themselves whether their worry is productive or unproductive (see image, below). “Is it something that you can actually do something about?” Kuhn asks. “If it’s unproductive, then you need to just let it go. Do something you enjoy or focus on something else to reset [your mind].”

> Mind-body focus and exercise. Mindfulness, meditation and other calming interventions can be particularly helpful for clients with anxiety. Kuhn recommends the smartphone app Pacifica, which prompts users with breathing, relaxation and mindfulness exercises, for both practitioners and clients. Kuhn, who has a background in sports counseling, and Pisarik, who is a runner himself, also prescribe exercise to anxious clients. Exercise boosts serotonin, a neurotransmitter connected to feelings of well-being, and comes with a host of other wellness benefits. In addition, exercise allows a person to get outdoors or disengage from work and home activities and other people for a brief period to “have time to hear your thoughts and challenge them,” Pisarik says. “You have to hear your thoughts if you’re going to challenge them.”

> The butterfly hug. Beth Patterson, an ACA member and LPC with a private practice in Denver, teaches deep breathing exercises to anxious clients to help them become grounded, focusing on the flow of energy through the body. She also recommends the “butterfly hug” technique. With this technique, clients cross their arms across their chests, just below the collarbone, with both feet planted firmly on the floor.

Clients tap themselves gently, alternating between their right and left hands. This motion introduces bilateral stimulation, the rhythmic left-right patterns that are used in eye movement desensitization and reprocessing. “It’s phenomenally self-soothing,” Patterson says. “Doing that with deep breathing really helps with anxiety. I love the idea that you’re hugging yourself. Even just doing that helps.”

> Walk it out. Along with deep breathing and grounding, Patterson also recommends walking and movement for clients who are feeling anxious. She instructs clients to focus on the feeling of each foot hitting the ground instead of their anxious thoughts. As with the butterfly hug, this action creates bilateral stimulation, Patterson notes.

Bennett also uses walking as a way to help clients refocus their thoughts. She will take clients out of the office during a session for a “mindful walk” up and down the block. During the walk, they talk about what they’re sensing, from the sunshine to the breeze to the smell of flowers. Bennett says this allows her to work with clients “in the moment,” recognizing and refocusing anxious thoughts as they come. Afterward, they process and talk through the experience back in the office.

“It’s a lesson that [anxious] thoughts are going to come up for you, and you can refocus on your sense of touch or hearing,” Bennett says. “Thoughts will come up, and it’s really easy to attach to those thoughts and become anxious, but we can acknowledge the thought, be accepting of it in the moment and refocus. Change and connection can come that way.”

> This is not that. Clients commonly transfer anxiety-provoking personal issues onto relationships or situations in other facets of life, including the workplace, Patterson says. For example, Patterson worked with a client who had a very domineering, controlling mother, and this client felt triggered by a female boss in her workplace. Patterson introduced the client to the mantra “this is not that,” and they worked on reframing the anxiety the client experienced when she felt her boss was being controlling.

“She had to work through it in a beneficial and compassionate way for herself and really remember ‘this is not that,’” Patterson says. “Our minds are brilliant, but they’re binary computers. When something happens, it will immediately associate it with something else it knows. If a co-worker is being overly competitive, it might trigger feelings about sibling rivalry. This [mantra] offers a great opportunity to work through family-of-origin issues [with clients] when you see them replicated in the workplace.”

> Abstain from negativity. Another empowering tool clients can use is to become conscious of and then avoid unhealthy or toxic situations and people who trigger their anxiety, Pisarik says. He advises clients to “stay away from groups of people or individuals who they know will engage in negative self-talk or negativity. If you’re feeling anxious already, the last thing you want to do is to go and talk to that toxic person.”

Similarly, he commonly advises anxious students to avoid waiting outside the room where they’re about to take a big exam, surrounded by 30 classmates who might be saying that they are going to fail, they didn’t study enough, they don’t feel prepared and so on. Counselors can coach anxious clients to think ahead and prepare ways to remove themselves from these types of situations, regroup and redirect their thinking, Pisarik says.

> Lifestyle choices. Counselors can also educate clients on the connection between anxiety and lifestyle choices such as sleep patterns, exercise and diet, Pisarik says. For young clients especially, this also includes social media use, he notes.

Pisarik says he frequently talks with his college-age clients about their alcohol consumption, drug use, irregular diet and other aspects of the modern university experience. “The lifestyle of a college student is absolutely conducive to generating anxiety,” he says. “While they are college students, I get that — their job is to have fun and sleep whenever [they] want. But building some sort of healthy routine is important, [including] getting enough sleep and making sure they eat well. I tell them to try and maintain the diet they had at home. … If you’re struggling with anxiety to begin with, any one of those [elements] can add to it, and those are really easy fixes.”

For Bennett, conversations with clients about lifestyle also include questions about smoking and caffeine use. Both tobacco and caffeine can make a person shaky or make his or her heart and mind race, which can trigger or exacerbate anxiety, she points out.

In addition to social media use, Pisarik also asks clients about their social engagement, such as participating in sports or other hobbies. Clients who struggle with anxiety often isolate themselves, he notes, so he works with them to identify social outlets, from volunteering to joining a school club. This sense of connection can reduce anxiety, he says.

> Narrative therapy and externalization. Patterson finds narrative therapy helpful when working with clients with anxiety because it allows them to externalize what they’re feeling. When clients uses phrases such as “I am worried” or “I am anxious,” Patterson will gently redirect them by saying, “No, you’re Susan, and you have a problem called worry.”

“Externalize the problem,” Patterson explains to clients. “Externalize it and dis-identify it. See it outside of yourself. … ‘I can deal with that because it’s not who I am.’ … If you’re carrying it around as if it’s you, you can’t do anything about it. The truth of the matter is, it’s not you.”

Counselors can also help clients with anxiety to focus on a time in their lives when they faced a similar challenge and got through it, Patterson says. She asks clients questions to help them probe deeper. For example: How did you handle that challenge? What worked, and what didn’t work?

Working with clients on medication

Anti-anxiety medications are commonly prescribed in the United States. Their prevalence means that counselors are likely to encounter clients who are taking medication to control their anxiety symptoms.

Regardless of their feelings about the use of psychotropic medications, practitioners must treat and support clients who are taking such medications the same as they would any other client, Kuhn says. “I never treat someone differently based on their medication. They get the same CBT therapy that anyone else would get,” she says, adding that the most important thing is to ensure that clients don’t feel judged by the counselor.

Kuhn has seen anti-anxiety medications work well for some clients. “It can take that little edge off that they need to get through the day and be able to function,” she says. At the same time, she also has clients who express a desire to be able to stop taking their medication eventually.

Pisarik notes that for anti-anxiety medication to work well, clients must remember to take it faithfully, keep track of how it makes them feel and schedule the repeated appointments needed to monitor and adjust dosage levels. Each of these elements can pose a challenge to college-age clients. “It’s a lot of work, and [college students] often lack the discipline and time to get it right,” Pisarik says.

Bennett agrees, suggesting that even though professional counselors are not the ones prescribing medications, they still need to discuss and explore medication use with their clients. She also stresses that practitioners should be knowledgeable about the different kinds of medications that clients may be taking and their possible side effects.

Bennett sometimes conducts conference calls with her clients and the medical professionals who are prescribing them medications so that she can help clients ask questions and otherwise be a support to them. “We [counselors] don’t prescribe, but at the same time it’s very important to collaborate with whoever is prescribing the [client’s] medication,” she says. “Be supportive and involve the client in conversations: How long have you taken it? Have you noticed any side effects? Has it been helping? Talk about how often they’re supposed to take it and if they’re adhering to that. There can be stigma about taking medications, so it’s important to normalize it. … It’s comforting too for the client to know that you’re on their side, and part of that is collaboration [about medication].”

See the person, not the anxiety

Given how common anxiety disorders are, it’s likely that any counselor’s caseload will be filled with clients presenting with symptoms of anxiety. It is important, however, for counselors to treat each client as an individual and to tailor the therapeutic approach to meet that client’s unique needs, Bennett emphasizes.

Building trust and a healthy therapeutic relationship are key in treating anxiety because clients can feel very vulnerable as they talk about what makes them anxious, Bennett points out. That is why it is critical to get to know these clients as individuals rather than through the lens of their anxiety.

“Don’t assume that because they’re anxious, they’re going to think and behave like other people with anxiety,” Bennett says. “Meet them where they are and find out what’s most effective for them based off of their interests. It can be empowering for clients to integrate their own interests and life experiences into the therapeutic process. Not only does this create buy-in for the client, but it can also help in creating a safe space to begin exploring the vulnerabilities that come along with anxiety. … Hear their story, find their strengths and give them a voice in the process. It’s important to honor them as individuals.”

It won’t be news to most readers that undergraduate students everywhere encounter an incredible amount of stress throughout their college years. Colleges and universities offer a considerable range of services and programming to address a variety of stressors, including test anxiety, financial hurdles and personal struggles.

Even with all that focus on helping students to mediate stress and anxiety, I think one source of stress often gets overlooked: career stress. After nearly 15 years serving as a career and academic counselor for undergraduates, I am disheartened that such an oversight remains prevalent, both nationally and internationally, among administrators in higher education.

In a recent survey of 131 undergraduate students, I found that only 12 percent remained undecided regarding what major they wanted to pursue. To assume that only 12 percent of these students remain stressed is misguided, however, especially when learning that 56 percent of respondents to the survey were still uncertain concerning the career path they wanted to pursue. From firsthand experience, I know that this uncertainty causes considerable stress and anxiety for undergraduates.

As for the survey? Of the students who participated, 49 percent indicated that they endured stress over deciding on a major or career path.

Why are so many students battling this stress? We certainly have incredible assets in place to provide undergraduates with career guidance. Most four-year colleges and universities have

career centers staffed with career counselors to help students research majors and career paths. In addition, career centers often offer enrolled students access to free career assessments, including the Strong Interest Inventory, FOCUS, Myers-Briggs Type Indicator or an array of other assessments based on the Holland Career Codes. But even with all these resources available, students rarely utilize career centers for much beyond getting help writing a résumé or cover letter during their senior years (admittedly, I was guilty of this too). Therein lies the problem.

Fellow career counselors and coaches know the following advice all too well, but for other counselors who are working with undergraduate students, I’d like to offer some insight into helping them navigate their career research and mitigate the stress that all too often accompanies that search.

1) Get students to visit their campus career center during their first semester at college. I understand students have a lot to contend with as they enter their first semester of college. Between getting comfortable with the layout of the campus, the location of their classes, college-level course work and the campus food, the first two weeks of the semester are not an easy time for students who are seeking to begin their exploration into majors and career paths. By the third week, however, I find that students are ready to invest time into career research, and a visit to the career center is a good first step. Before sending my students to the career center on campus, I provide them with an overview of the center’s resources and the services the staff provides to undergraduates. Additionally, I discuss career assessments with my students and the information they can glean from assessment results.

Counselors familiar with the career assessment used by a student’s campus career center can provide students with background on the assessment, including information on the assessment’s format and how to access the assessment online if that is an option. Additionally, it is a good idea to stress the importance of seeking a full interpretation of the assessment results by one of the career specialists at the campus career center. In some instances, students can receive assessment results without having to speak with a career counselor or career coach whose expertise includes interpreting these assessments. As I tell my students, they will undoubtedly be able to gain insight from the assessment themselves, but I also stress that there are a multitude of intricacies they will likely overlook. These are bits of information that a career specialist would be able to identify and interpret for the student — information that could be crucial in helping a student identify an appropriate major or career path to pursue.

To avoid a lot of the hesitation and accompanying stress that students have with visiting a career office, I find it helpful to provide students with a few questions to ask the career center staff. In particular, I advise students to ask about the center’s career assessment and how to set up an appointment to go over the results. For those students with majors already in mind, advise them to ask if a particular career center counselor has experience helping students in that major.

A final step is to make certain students know where to find the career center. Yes, it is relatively easy in most cases for students to determine where on campus the career center is located. However, I find that providing the contact information to the students increases the likelihood that they will follow through and visit the career center. Take the extra minute or two to show students the career center’s website, and then email students the center’s contact information, including room location, email and phone number.

2) Seek a follow-up with the student. Before I end my initial meeting with students, I ask them to meet me after their meeting(s) with career center staff. I find that doing so encourages students to follow through on the guidance and their career research. These follow-up meetings offer the opportunity to mediate any stress that arises from visiting the career center. Specifically, students are often stressed that one visit to the career center did not help them immediately decide on or discover the best major and career path for them.

During these follow-up meetings, I help students develop (or adjust) their career research plans. Those counselors who are certified and proficient in the career assessments their students have taken can use these meetings to address student misunderstandings about their assessment results and expand on any feedback the students received from career center staff.

3) Seek additional follow-up after the student completes the assessment. In the event the student took an assessment but did not review the results with a career specialist at the college career center, advise the student to return for a review from the career center staff. It is critically important that students receive that feedback from those who are trained to interpret the results. I have found that the majority of students who meet with career center staff for guidance report that these meetings help reduce their stress and anxiety related to career concerns. In my current survey, 78 percent of respondents indicated that their meetings with a career counselor helped them decide on a major or career path. Furthermore, 69 percent of respondents indicated that meetings with a career counselor helped reduce their stress surrounding career and educational planning.

4) Advise students to communicate with professors on campus whose specializations match the students’ career interests. Even the most experienced career counselor has limited knowledge of the diverse job opportunities afforded by every major and degree. For example, from my personal experience, none of the career counselors on my college campus knew the array of specialties within anthropology, a field that leads to careers beyond professorships, museum curators and forensic specialists.

This is where campus professors are so vital to a student’s career research. The professors in each department likely possess a wealth of knowledge regarding job opportunities and career specializations that a given major affords students. Unfortunately, students often fail to seek career guidance from department professors earlier on (i.e., freshman or sophomore year).

As career counselors, it is incumbent upon us to direct our students to department professionals. Again, drawing from my own experience, speaking with department professors helped me to identify and focus on short-term and long-term careers, which ultimately reduced my stress (especially when many individuals asked me what in the world I was going to do with an anthropology degree).

5) Advise students to communicate with professionals in the communities surrounding the college campus. Connecting with campus professors/professional staff is often not enough to provide college students with a full understanding of the potential (career-wise) that each major offers. To that end, it is important to encourage students to reach out to community professionals to gain an extensive understanding of the possibilities that exist. Another benefit to reaching out to community professionals is that students may learn of unadvertised job opportunities during these discussions, all while expanding their professional networks. What’s more, engaging with professionals who have already put the student’s major into practice often helps to put the student’s mind at ease.

6) Encourage students to seek field experience during summer breaks. Summer vacation is a time for college students to reenergize. That said, there is no reason why students can’t use the summer months to further investigate their major and the career opportunities the major offers. Finding part-time, full-time or volunteer employment opportunities is a great way to gain firsthand experience in the field. Encourage students to speak with their professors and the community professionals with whom they connected to determine what jobs or volunteer opportunities exist that would provide related experience and help students gauge the appropriateness of the major they are currently pursuing.

Such summer experiences are more prevalent than most students and counselors might realize. It comes down to asking the right people what opportunities exist. In addition to giving students related experiences to include on their résumés, such jobs could provide money for college and help students expand their professional networks. Based on my own undergraduate experience, such opportunities reduced student stress by helping them gain a better understanding of the course material from the major, while also revealing hidden career paths not often attributed to the major.

7) Remind students that it’s OK to change their minds regarding their career goals. So what happens when students follow the above advice and determine that they are pursuing a major or career path that is unsuited to their interests, strengths and long-term career goals? Changing a major can be extremely stressful for students because they often feel it is a sign of failure. I remind students that changing a major is a common occurrence. At the same time, I also remind them that it is better to change directions with their newfound knowledge of their major and themselves now than to wait; it is a decision that could save them considerable time and money later on. It is also important in such moments to congratulate students for their efforts. This is encouragement that will help them tackle the stress and worry that often follow a change in major.

Collectively, these strategies have aided me in reducing my students’ stress, while simultaneously helping them determine a worthwhile career and gain valuable field experience prior to graduating. It is especially rewarding when one of my advisees follows through on this advice and has a full-time job lined up before graduation because of connections that he or she has made with community professionals. It is even more rewarding when graduates from years past return to say they still love the major and career paths they pursued after completing the aforementioned research. I believe other career counselors might find similar results as they assist students in managing stress related to choosing majors and career fields.

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Neil O’Donnell is a senior counselor for SUNY Buffalo State’s Educational Opportunity Program, where he provides personal, academic and career counseling to undergraduates. O’Donnell is also the author of The Career-Minded Student, a book that provides a plan of action that helps undergraduates succeed in class while preparing to compete for jobs immediately after graduation. Contact him at odonnenp@buffalostate.edu.

Anxiety, confusion and questions of identity greet many college seniors as they consider their impending graduation and the necessity of determining their next steps in the ‘real world.’ wp.me/p2BxKN-3PD

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Choosing the right graduate school for counseling can be both a challenging and exhilarating experience. Applicants have many motivators to weigh when making this decision and often have many choices concerning which school and program will best fit their needs. This article shares the stories of four students who recently chose to enter a master’s program in clinical mental health counseling. Additionally, each student provides tips for other individuals who are contemplating the decision to enter a graduate program in the mental health field.

Essence

Before entering graduate school, I found myself caught in a dilemma. I had just finished my bachelor’s in June 2015, and here I was in August 2015 not making enough money with a bachelor’s degree to independently support two children.

I always wanted to complete graduate school, but I was nervous and hesitant about the debt that it might cause. After much consideration, I decided to enter graduate school and view the debt in a different light. Either I was going to put myself in debt by struggling to care for my children, or I could put myself in debt because I invested in my education to get to a better situation financially.

I set my fears aside and began to research schools that interested me. I knew that in my future career, I wanted to have the knowledge, skills and training to counsel all individuals, not just children. I decided to complete a master’s in clinical mental health counseling because I wanted to counsel children, adolescents and adults with developmental trauma.

When choosing a graduate school and field, I knew that I had to choose a field that I liked because it would be hard to invest myself in a school or field that I did not care for. As my graduate school experience began, I felt nervous and anxious. I had to remind myself that nothing comes easy and that the rewards would be worth it in the end. I noticed the further I got into the program, the less scary the experience became. I was more scared of the title “master’s degree” than anything else. The moral of this story is to overcome fear, because fear kills so many dreams and aspirations.

Currently I am a full-time worker with two small children. The support system I have is amazing. Graduate school became more stressful toward the end of my first term, but it was still manageable. In the future, I hope to have my own practice, and I would like to be involved in consulting. I would like to counsel adults with developmental issues and children who have experienced sexual trauma and physical abuse.

Graduate school will challenge you and reward you. In graduate school, you will learn how to master your writing and time management skills. My first tip to readers is to stay totally invested in your education despite your doubts. My second tip as you struggle through graduate school is to remember that to whom much is given, much is required.

Nayo

My first encounter with the counseling world happened when I was 8. My parents took me to see a counselor so that I could work through my confusion about their divorce, among other things. At 8, I was far more aware of the world than most, and I really didn’t care to spend my time in a counselor’s office once a week, especially because I felt belittled by my counselor. He spoke to me like an unaware child who couldn’t comprehend my emotions. The anger I felt toward my counselor turned into a sympathetic compassion for others like me — for others who felt like they weren’t being heard.

I turned this compassion into a career path and have aimed to change the system and those who work in it ever since. In my path, I have encountered terrible testimonials that made me weep for those who turned to the mental health and substance abuse care systems. They expressed to me that they too felt belittled. This has driven my passion even further and motivated me to continue my education beyond my undergraduate degree.

Deciding whether I wanted to go to graduate school was a long process. I had to consider if school was necessary to achieve the goals I wished to accomplish. I had to first make sure that the school I chose had an accredited degree program that would prepare me with the knowledge I need to pursue my goals. Finding a school that was CACREP accredited but also helps students obtain licensure was very important.

Currently I am pursuing my degree in clinical mental health counseling. I wanted a school that would build not only my fundamental knowledge but my professional knowledge as well. Not only is the school providing me with the basic knowledge I need to be a counselor, but it also provides me with opportunities to be experienced in the counseling field, which is a bonus. Having proper knowledge about the legalities of my career choice is very important in my pursuit to change the current systems.

I hope to open up more doors for people not only to get the help they need, but also to feel comfortable enough to do so. My future goals are to motivate counselors to take the time to listen to their clients and figure out what their problems are before diagnosing them for life.

Since being in graduate school, I have learned two things that I believe all those in pursuit of higher education should know. My first tip for those considering or starting the graduate program is to always use your resources. Making connections with the faculty around you and using the educational resources provided on campus are good ways for you to excel academically and to grow your network. Talking to people who have already achieved the professional or educational goals you are pursuing is a great way to learn the customs of pursuing professional and educational goals.

The second tip all potential graduate students should know is to develop time management skills. Depending on your school choice, the pace of the school may be more or less than you are accustomed to. This can cause you to become either overwhelmed or stagnant, either of which can have large effects on your grades. It’s important to schedule time to complete and comprehend your assignments while also providing yourself with downtime to prevent burning out.

So, the next time you consider whether graduate school is worth the effort, it is. Taking the time to advance yourself in life, in any facet, can open doors far beyond what you might imagine.

Thomas

I was led to counseling in high school after taking an intro to psychology course. Learning about the mind and the way it works piqued my interest because I was coming to accept the fact that I was gay.

Children are very conscious, and as a child I came to the understanding rather quickly that being gay was not acceptable in society. I discovered that I was considered mentally ill until 1987, when the decision was made to remove homosexuality from the Diagnostic and Statistical Manual of Mental Disorders. I felt like a normal, conscious person, but society told me that my thoughts were not normal or conscious. I knew that something was wrong with this idea. When I made it to a bachelor’s program in psychology, I realized that I was not alone, and I wanted to help others like myself.

After graduating with my bachelor’s degree in psychology, I felt that I was equipped with the foundation I needed to start my journey, but I wasn’t qualified to provide help in the context I desired. I quickly realized that I would not be able to fully fulfill my purpose without an advanced degree. My reason for choosing a master’s in the clinical mental health counseling program was because I enjoyed the idea of sitting down and helping people work through their problems as a clinician, as opposed to the assessment and testing angle that a psychology master’s would provide.

I have always been ambitious, and the idea of continuing my education has always been a driving force in my life. I relocated from Florida to Georgia in 2009 for a job opportunity at a residential treatment facility, and I decided to continue my education. Of course, life doesn’t go exactly as we plan it out, and establishing a life for myself via full-time employment prevented me from starting school right away. But I knew the stars would align when it was my time.

It was a difficult decision because I had to continue working full time and needed flexibility. I was determined to make it work, and I was accepted into graduate school for my master’s in clinical mental health counseling in October 2015.

Currently, as a student in my first term, I am surprised at how much I am analyzing myself while learning the material. I realized that counselors must explore their own lives and personal experiences to effectively help others understand their experiences. Realizing things about myself and how I fit into the spectrum of life gave me a sense of purpose and opened my eyes to the importance of helping others realize their purpose. The curriculum in my Foundations of Mental Health Counseling course definitely helped me solidify and understand my professional identity and equipped me with a wealth of knowledge about myself.

My tips for those considering or starting a graduate program are to be ready to face yourself and any issues in your personal life, such as your sexuality, that may be barriers to your own success. Students should use the experience as a sense of self-therapy in an attempt to prepare to help others. Also, to ensure success, students should become comfortable with writing. I have always been a writer, and I love to express myself through words. With the help of the available resources for writing in graduate school, students should graduate as better writers than they were when they started.

Kimberly

My interest in the world of counseling embarked when I decided to leave a life and career in the music industry that was full of glitz and glamour. However, I strongly believed that I was choosing a path that felt much more rewarding. A path filled with light. A path that has purpose and endless possibilities to make a difference in the lives of other individuals who are in need of some guidance and encouragement.

My decision to enroll in the clinical mental health counseling program derived from the passion I have to help at-risk youth gain skills to overcome their struggles and obstacles. This passion came from the struggles I personally faced as an at-risk child. Fortunately, I was lucky to have two individuals who helped me learn the skills I needed to be able to succeed in life, and I was inspired to do the same for other at-risk youth.

My decision to enroll in the clinical mental health counseling program came close to three years after I had received my bachelor’s degree in psychology. My passion to succeed in life and help those individuals who need that extra push or guidance was far stronger than the doubt and obstacles I had about enrolling in graduate school. Additionally, I realized that with a bachelor’s degree in psychology, I was limited from being able to achieve my future goals. Furthering my education became almost impossible to ignore.

After doing extensive research on graduate schools, I came across one school that really stood out to me. The flexibility of the program’s schedule, the scholarly faculty and the fact that the program was CACREP accredited was very influential in my decision.

My current experience in my first class has come to an end and has proved to be very informative and motivational. This class is called Foundations of Mental Health Counseling and truly embodies the foundation of everything the clinical mental health counseling program consists of. In all honesty, I was extremely nervous when I first started this class because I had no idea what to expect. I also had reservations about how it was going to affect my personal and work life. Fortunately, now that I am at the end of the course, I can say that this class has helped calm my nerves and given me some insight on what to expect in future classes and in the counseling field in general.

My future goals consist of running my own practice; playing a major role in implementing a program inside school systems to either replace suspension or work hand in hand with suspension; and starting a nonprofit organization that empowers at-risk youth and troubled families while positively influencing school systems and communities worldwide. To some, it may seem as if I am biting off more than I can chew. However, in my eyes, if you truly want something in life, it is up to you and only you to make that dream turn into a reality.

My tips for those considering or starting a graduate program are to make sure you engage in self-care and to study smarter, not harder. Engaging in self-care can help you avoid burnout and keep a healthy balance between work, life and school. Some examples of self-care are working out, meditating and practicing mindfulness.

Learning how to study smarter and not harder is also very important to your success. Staying organized, using good time management, taking good notes and reviewing them consistently are all ways that you can study smarter and not harder. In the end, remembering why you entered the graduate program should be your biggest motivator.

Conclusion

The backgrounds, personal stories and inspirations behind counseling students’ decisions to attend graduate school are unique to each individual. Whether those experiences are as a mother, a former patient, someone accepting his sexual identity or just someone with natural talent, we all share a passion to learn about what it takes to help bring about the best in all of us.

Counseling students share a set of values that all people in helping careers possess, including empathy, passion and a nature of selflessness that ensures we are helping our clients reach their full potential. Future counseling students should know that this career is about more than personal gain or financial stability; it is about changing the world one client at a time.

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The authors of this article were students in a Foundations of Clinical Mental Health Counseling course at Argosy University, Atlanta, taught by associate professor Allison L. Spargo. Tanisha Johnson, a doctoral student, served as a teaching assistant. Both Spargo and Johnson are members of the American Counseling Association.

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Often parentally micromanaged, pressured by high expectations, grappling with depression and anxiety, a bit socially awkward or just a little bit lost in a strange new world, today’s college students are seeking counseling in greater numbers than did previous generations, according to college counselors and other experts.

Those who counsel students point to various factors for this surge in clients, including greater overall awareness of mental health issues, higher rates of depression and stress, and a huge increase in the overall student population at colleges and universities. According to the Institute of Education Sciences, the research and statistical arm of the U.S. Department of Education, between 1992 and 2012 (the latest year for which statistics are available), the number of students enrolled in degree-granting institutions has grown by 39 percent.

National surveys conducted by the American College Counseling Association (ACCA), a division of the American Counseling Association, indicate that the percentage of students struggling with serious mental health issues has also increased. In addition, 42.4 percent of the almost 75,000 undergraduate students who completed the 2015 annual American College Health Association National College Health Assessment reported experiencing greater than average stress within the past 12 months, and 10.3 percent reported feeling tremendous stress. When asked about depression and anxiety during the previous 12 months, 35.3 percent of survey respondents reported feeling so depressed that it was difficult for them to function; 57.7 percent indicated feeling overwhelming anxiety.

At the same time, staff growth at college and university counseling centers has typically failed to keep pace with this increased burden. As a result, these counseling centers are often scrambling to stay on top of their caseloads, and college counselors are using a variety of campus resources and outreach methods to meet the needs of today’s students.

Welcome to the new world

One of the defining features of the traditional college experience is leaving the nest. But many students in the current generation are having trouble finding their wings, according to college counselors. That’s in part because, generally, today’s young adults are used to their parents managing many aspects of their lives, says Suzanne Degges-White, who supervises student counselors as part of her role as a professor and chair of the Department of Counseling, Adult and Higher Education at Northern Illinois University.

“We’re dealing with helicopter parents,” she says. “They’ve done so much [for their children]. And then when you get to college, your teachers don’t care if you do your homework, and your parents aren’t there to remind you.”

“There’s this idea that kids need protecting, so when they get to college, suddenly if they don’t like a class or their roommate, this may bring them in to the counseling center,” adds Degges-White, the ACA Governing Council representative for the Association for Adult Development and Aging.

ACCA President Amy Lenhart agrees, saying that the students she sees often seem ill equipped to handle many of the demands they face, such as managing their academic workloads, interacting with instructors and other students, and even getting to class on time. Both Lenhart and Degges-White say they regularly encounter students who have trouble making any kind of significant decision on their own. In some cases, parents are still trying to make all the decisions for their college-age children, says Lenhart, who works with students on general counseling issues and career concerns at the counseling center at the Preston Ridge Campus of Collin College in Frisco, Texas.

“I can tell you that even in counseling, parents want to make appointments [for their son or daughter],” she says. She has also encountered parents who want to sit in on their son’s or daughter’s career counseling sessions. In such cases, it is important for counselors to set boundaries and let parents and students know that it is time for these young adults to make certain decisions on their own, Lenhart says.

The consequences for students who struggle to make decisions and manage their lives can be severe, Degges-White says. Not studying, skipping classes and failing tests can quickly lead to academic probation, she points out. Although it is easy to dismiss such behavior as laziness or a lack of interest, Degges-White contends that would be a mistake. Instead, counselors need to ask students about their classes, including why they’re not going or why they think they’re failing a particular subject, she says. The answer may be related to poor time management, and many colleges have workshops to which counselors can refer students.

Of course, there may be other underlying reasons. “Sometimes students don’t go to classes because they are not interested in them,” Degges-White says. “Maybe they aren’t suited to the subject or even need a different major.”

However, if the behavior is due to a lack of accountability, counselors should work with students on making decisions and then accepting the consequences, Degges-White says. She likes to use choice theory to help students explore the options available to them. “How are the choices you are making now going to get you to your goals?” she asks. “If they’re not, what other choices can you make?”

ACA member Nick Patras, a licensed professional counselor and assistant director of the counseling center at Texas A&M University-Commerce, dissects the time management process with his clients. Sometimes students come to the counseling center after their first semester having failed several classes and hoping for an easy and instant answer, he says.

Instead, Patras delivers a dose of reality, but he also tries to provide helpful strategies to get the students back on track. “Do you have goals? Do you have projects? Do you have them broken down into stages, or do you wait until the last minute?” he asks these students. “I educate them on how to plan and manage projects by breaking them down into little bites.”

Knowing your students

Josh Gunn, the director of counseling and psychological services at Kennesaw State University in Georgia, urges college counselors to be aware of their campus culture and who their students are. For instance, Kennesaw State’s student body features a significant percentage of first-generation college students, he notes.

Parents who have been to college generally impart at least a minimal amount of knowledge to their children about how college works, but first-generation students don’t have that advantage, says Gunn, a member of ACCA. Not knowing anything about college life can pile on an additional layer of uncertainty and stress, he points out.

First-generation students are also more likely to be putting themselves through school, which may mean working a job in addition to attending classes, Gunn says. For these students, academic struggles may be at least partially tied to general financial stress or simply not having as much time to focus on their studies, he explains. Counselors should consider how putting students in touch with other resources such as the financial aid office or an academic adviser might relieve certain stressors for students, he says.

It’s also important for counselors to keep in mind that not all college students are young adults fresh out of high school. Some students, especially on today’s campuses, are individuals who are beginning or returning to college later in life, Degges-White points out. These students are confronting many of the same stressors as their younger peers, but they will be juggling those stressors with work and family concerns, she says.

Lenhart’s institution is a community college, which means that its students don’t have to meet the enrollment requirements that applicants at four-year colleges and universities do. Because of this, she explains, some of those who enroll — for example, a 50-year-old student who hasn’t taken classes since high school — might not be ready for the courses he or she is taking. It’s important for counselors to consider factors such as these when students come in with academic problems, Lenhart says. What seems like (or may in part be) a time management problem could actually involve a skills deficit for which counselors should refer students to the tutoring center and their academic advisers, she says.

When academic performance is a predominant concern for students, it affects every area of their lives, including their mental health, Gunn says. Therefore, when students come to the counseling center and present with depression, anxiety or stress, it is important for counselors to ask how their courses are going, because academic concerns may be exacerbating whatever other issues they are concerned about, he says.

Counselors should also keep in mind that if a student is struggling with academics, that issue doesn’t necessarily go away just because the mental health problem has been addressed.“If you’ve cured someone’s depression but they flunk out, you’ve failed,” Gunn says.

Making new connections

Joel Lane, who studies the theory of emerging adulthood and is the coordinator of the clinical mental health counseling program at Portland State University in Oregon, says that, traditionally, a person’s late teens and early 20s were when attachment relationships shifted from one’s parents to peers and romantic partners. Possessing the ability to form and maintain these healthy attachments is especially important in times of transition and can affect not just an individual’s personal life but his or her professional life as well, he says.

However, for members of the millennial generation, that process has become more complex for several reasons, according to Lane. One is that young adults (ages 18-25) are “younger” psychosocially than previous generations have been. Millennials’ identity exploration is taking place at a later age when they are no longer adolescents but when they do not consider themselves adults yet either, he says. Also, because their parents often continue to manage their lives, these young adults may be less likely to seek other sources of emotional support, at least in the “real” world, Lane continues. Where today’s young adults tend to turn to seek support and interact with others is social media, he explains. And although social media may be good for those purposes, it does not generally prepare young adults for making connections and conversing in their classes, in social situations or on the job, Lane contends.

Unfortunately, many college counselors report that social anxiety — which negatively influences a person’s ability to form new attachments — appears to be much more prevalent among today’s students than in prior generations and is a factor in a significant number of their clients’ cases. Patras says that about half of his cases involve social anxiety as either the presenting concern or an aggravating factor. Often, he says, the students he sees simply do not understand how to interact with others.

“They don’t know how to talk to people, how to carry on a conversation or how to ask someone out,” Patras says. “It’s partly socioeconomic” — the university where Patras works is located in a rural, impoverished area — “but [it’s] mostly because they are interacting on social media and not in real life.”

Lenhart and Degges-White have observed this as well. Although none of the three counselors believes that social media is inherently bad, they do think it has caused a significant shift in how young adults interact with one another. “They say they are ‘dating,’ but they might just be interacting on Facebook or through texting,” Patras notes.

Although it’s true that adolescents and young adults are establishing social networks online, they typically do this in solitude at their computers or on tablets instead of learning face-to-face communication and interaction skills, Degges-White says. She adds that many of today’s college students spend their social time video chatting with friends from home rather than going out and making new friends.

Technology does provide its own kind of connection and access to a wide array of helpful resources, Lenhart acknowledges, but it is also easy to hide behind, particularly for those with social anxiety. “We want them to actually be out in the world,” she emphasizes.

Which is why some college counselors are gently but firmly pushing students out of their comfort zones.

For instance, Patras holds workshops on social skills. He teaches students how to integrate into an unfamiliar group by first finding one person within the group to talk to. When participants ask how to start a conversation with someone they don’t know, he tells them to ask the other person about himself or herself. “Everyone likes to talk about themselves,” he says. In the workshops and in individual counseling, Patras also teaches students relaxation and emotional regulation skills such as mindfulness meditation and deep breathing to help ease their anxiety.

Lenhart asks students to try attending social events such as campus group meetings or parties. “Just challenge yourself,” she urges students. “Make sure you have a way you can leave if you get uncomfortable, and just stay, even if it’s only for 10 minutes.”

Degges-White believes a combination of cognitive behavior therapy and a bit of desensitization therapy is effective in helping students overcome social anxiety. Her counseling center also refers students to small group sessions in which students can practice talking to one another. Degges-White has also found that giving “homework” assignments to students, such as having them talk to at least one person in one of their classes each week, encourages greater social engagement. Because a lack of social skills is becoming more common in young people, even high schools are beginning to offer groups that focus on these skills, she says.

Managing mental health needs

College counseling centers don’t just deal with students’ issues related to time management, academic adjustment, social skills, being away from home for the first time, getting used to living with other people and, as time goes by, choosing a major and career path. The age range when most people go to college — late teens to early 20s — is also the age at which serious mental illnesses such as depression, bipolar disorder and schizophrenia often appear. College is also a time when many people choose to begin experimenting with drugs and alcohol, which can lead to substance abuse problems.

Unfortunately, the level and length of care that college counselors can provide to students experiencing serious mental health issues varies greatly. Patras says that his counseling center currently has the resources to work with students for as long as they need it and are willing to do the work. According to Patras, the small city of Commerce has only two mental health professionals, and many of the university’s students don’t have private insurance, so the school’s counseling center is a particularly essential resource.

Other institutions are forced to limit the number of sessions that each student is entitled to or else maintain long waiting lists because demand is so high, Lenhart says. Because of these limitations, many college counseling centers focus on triage. This involves getting the most severe cases in or, if necessary, referred out for hospitalization or psychiatric care immediately, and using brief interventions such as solution-focused therapy for less severe cases, she says.

Some colleges are relying more frequently on group therapy, which doesn’t count against students’ allotted center visits and has the added benefit of helping students interact with others, Lenhart says. This is especially important in cases in which students are dealing with depression or social anxiety, she adds. Groups can also be particularly beneficial for students dealing with grief, working through issues related to their sexual or gender identity and a wide range of other challenges.

Gunn says some of the counselors in his center are taking on the role of case managers in the more complex cases. These counselors get students who just got out of the hospital or have special needs set up with a psychiatrist or an on-campus counseling group.

College counselors are also reaching out to students to raise their awareness of the many services that counselors can provide; distributing psychoeducational materials and doing public screenings; and educating faculty and staff on spotting the signs of behavioral problems.

Gunn’s counseling center gives regular workshops on everything from decision-making to general wellness to sexual assault awareness. He believes that college counseling needs to become more proactive; not just to let students know where the center is located and say, “Come see us when you’re ready,” but to actively look for potential problems in hopes of preventing bigger ones. His staff regularly provides information about identifying behavioral problems to the resident life program, department heads and other faculty and staff. In addition to encouraging prevention, he hopes that counselors can help create campus cultures in which the belief becomes that safety is everyone’s responsibility.

Lenhart bemoans the lack of residence halls on the community college campus where she works because she believes that hall staff — due to their more frequent contact with students — serve as a sort of first line of defense for identifying students who may be struggling and in need of counseling. That doesn’t mean the college’s faculty and staff aren’t vigilant. In fact, she says, faculty and staff often bring students to the counseling staff’s attention and even walk those in need of help to the center if need be.

“We train them [faculty and staff] for what to look for,” she says. “Dropping grades; changes in appearance, such as becoming disheveled, not bathing; maybe acting out in class; maybe being angry — any kind of change in behavior that is unusual for that student.”

“We have to work harder at promoting counseling to students because of the come-and-go nature of our [community college] program,” Lenhart says. “I think, sadly, the assumption is that counselors at community college campuses are like guidance counselors.”

So, Lenhart and her counselor colleagues educate, educate, educate, conducting psychoeducational sessions and distributing informational fliers for national events such as Depression Awareness Day. Professors also have the counseling center staff visit classes and give presentations on stress and anxiety, she adds. She believes that classroom sessions not only help demystify what college counselors do but also get students more comfortable with the idea of coming to the counseling center.

Many colleges now have a kind of “college 101” class for incoming freshmen. The counselors interviewed for this article said it is important for college counseling centers to be involved with these efforts, either by providing educational materials or giving presentations.

Patras’ counseling center maintains liaisons within all of the university’s major academic departments and also works closely with campus police, who refer students to counseling if they have had trouble related to alcohol or drug use. The counseling center also educates other faculty and staff about possible indicators that students may need help, such as unusual acting-out behaviors (for example, outbursts in class), slipping grades or a previously responsible student who is now missing classes or not completing assignments.

Behavioral intervention teams are also becoming common on college campuses. The problem-solving teams typically include counselors and representatives from campus departments such as student affairs, campus police or security, student conduct and resident life, explains Brian Van Brunt, a past president of ACCA and author of Harm to Others: The Assessment and Treatment of Dangerousness, published by ACA. These teams meet regularly — typically once a week — to exchange information. The goal is to identify incidents or patterns that might indicate a possible problem — such as increased substance abuse arrests or a rash of suicide attempts — and to formulate a course of action with the goal of preventing larger problems.

Events such as the 2007 mass shooting at Virginia Tech provided the impetus for the creation of behavioral intervention teams, Gunn says. Even so, he cautions college counselors not to focus exclusively on such large-scale events. “Don’t waste all your time preparing for a mass shooting that may never happen,” he says.

Events such as a student’s suicide are more common, he explains, and likely to have a significant effect on campus mental health. To reach as many students as possible, counselors need to encourage an environment of multidepartmental sharing, he adds.

In many ways, counselors interviewed for this article say, college counseling has become a campuswide effort.

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Additional resources

For those who would like to learn more about the topics addressed in this article, the American Counseling Association offers the following resources.

“Passport to Wholeness: The Effects of a Campus Mental Health Fair on Help-Seeking Attitudes” by Lucinda C. West and Anita Knight

“Recovering College Students: Practical Considerations for College Counselors” by Mark S. Woodford

“The Effects of a Brief Mindfulness Intervention on Self-Compassion Among Undergraduate College Students” by Danielle Richards and William E. Martin Jr.

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The American College Counseling Association, a division of ACA, focuses on fostering student development in colleges, universities and community colleges. Visit collegecounseling.org to learn more about the division and to access its array of resources.